Hypothermic Carotid Arterial Flush for Induction of Selective Cerebral Hypothermia during Cardiac Arrest

Jung,  Yong Hun; Jeung,  Kyung Woon; Heo,  Tag; Min,  Young Il; Park,  Jong Seong; Kim,  Hong Jae; Park,  Chi Ho; Park,  Young Hun; Lee,  Seung Cheol

J Korean Soc Emerg Med > Volume 18(6); 2007 > Article

Original Article

Journal of The Korean Society of Emergency Medicine 2007;18(6): 537-545.

Hypothermic Carotid Arterial Flush for Induction of Selective Cerebral Hypothermia during Cardiac Arrest

Yong Hun Jung, Kyung Woon Jeung, Tag Heo, Young Il Min, Jong Seong Park, Hong Jae Kim, Chi Ho Park, Young Hun Park, Seung Cheol Lee

¹Department of Emergency Medicine, College of Medicine, Chonnam National University, Korea. neoneti@hanmail.net
²Department of Physiology, Chonnam National University Medical School, Korea.

ABSTRACT

PURPOSE:
Hypothermia has been demonstrated to protect the brain from reperfusion injury in patients suffering from cardiac arrest. We hypothesized that infusion of normal saline at 4 degrees C into the carotid artery (hypothermic carotid arterial flush, HCAF) during cardiac arrest would achieve selective cerebral hypothermia during cardiac arrest and cardiopulmonary resuscitation (CPR), without a detrimental effect on the rate of return of spontaneous circulation (ROSC) or significant impairment of cardiopulmonary function after ROSC.
METHODS:
Ventricular fibrillation was induced in 18 dogs weighing 12~18 kg, and circulatory arrest was maintained for 9 minutes. The subjects were then resuscitated using open cardiac massage. Group I (n=6) received no normal saline, while the dogs of group II (n=6) and group III (n=6) received infusions of 15 ml/kg and 30 ml/kg of normal saline solution, respectively, at 4 degrees C into both carotid arteries (cephalad) via 18 gauge catheters.
RESULTS:
Tympanic temperature decreased from 37.7 (37.5~37.7) degrees C to 34 degrees C within 1.2 (1~2) min and 1.0 (1~2) min from the start of HCAF in groups II and III, respectively. Thereafter, tympanic temperatures were maintained below 34 degrees C to 7.7 (1.5~14.5) min and 21.2 (12~37) min, respectively, from the start of HCAF in groups II and III. There were no significant differences in CPR-related variables or post-ROSC hemodynamic and laboratory variables between the two groups.
CONCLUSION:
HCAF rapidly induces selective cerebral hypothermia without detrimental effects on the rate of ROSC or significant impairment of cardiopulmonary function after ROSC.

Key words: Hypothermia, Heart Arrest, Cardiopulmonary Resuscitation